Introduction

The Teaching Program is interplay between adequate clinical material, high quality residents and a competent faculty operating in an educational and creative environment. Since much of the learning comes from this teaching interplay among peers, the "team" concept of the Resident on each rotation is very important. All residents participate in the SCORE Program which is the General Surgery Resident Curriculum Portal and take the review courses given on line. All interns starting from the academic year 2009-2010 are already registered and taking part in the Fundamentals of Surgery Curriculum by the American College of Surgeons.

These will help in the cognitive as well as in decision making of the residents. The acquisition of knowledge during the residency training is a progressive system that is not designed for the acquisition of specific knowledge or skills on any specific monthly rotation. Because competency in General Surgery requires broad based surgical knowledge and skills, each Surgical Resident will be assigned clinical responsibilities in the major surgical specialties during the course of the Residency training. These responsibilities can best be carried out in the context of a formal assignment to a defined clinical service. The Resident will be assigned clinical and operative responsibilities consistent with his/her experience and level of training. Each rotation must be considered a teaching rotation, and service needs must be balanced with educational requirements. Regular teaching conferences will be scheduled throughout the length of the rotation. Faculty supervision is essential for good and beneficial relationship between the Resident and Attending. The Resident will meet regularly with the assigned Faculty members during the course of the rotation, for teaching purposes and to review and evaluate the Resident's performance in the six general competencies. The resident will also be evaluated by other staff members as well as his/her peers. The curriculum, goals and objectives of the individual rotations will be reviewed by the resident prior to each rotation. Clinical experience gained by the Resident and the evaluations are compiled monthly and kept in the Resident's confidential evaluation folder. These are reviewed regularly by the program director and the associate program director and during the semiannual evaluation of the Resident by the Residency Advisory Committee.

 

To meet its goal, the program provides opportunities for resident to:

• Learn in depth the fundamentals of basic surgical science as applied to the practice of clinical surgery

• Develop the technical skills required to perform all major fundamental and complex operations in each of the primary components of general surgery and all fundamental operations in each of the secondary components of general surgery.

• Obtain experience in pre-operative, operative, post-operative and non-operative care for patients in all areas that constitute the primary and secondary components of general surgery.

• Participate in safe, effective, and compassionate patient care under supervision appropriate to level of training, ability, experience and responsibility.

• Assume progressive responsibility from assisting in patient care to complete management of patient care commensurate with level of training, ability, and experience.

• Participate in the educational and scholarly activities of the department by attending all required educational conferences, assuming responsibility for teaching and supervising junior residents and medical students and being involved in clinical and laboratory research under the direction of faculty members.

• Develop the personal habits required for ongoing professional and creative scholarly growth following completion of residency, through participation in journal clubs and preparation for departmental presentations.

• Develop an understanding of the ethical, socioeconomic, medico-legal and cost containment issues affecting the practice of general surgery.

• Participate in the evaluation of fellow residents, teaching staff, and the quality of education provided by the program.

• Develop a broader understanding of the role of surgery and its interaction with other disciplines such as Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Anesthesiology and Pathology.

The program expects the following objectives for each of the four major domains of learning to be achieved.

Cognitive

The resident shall demonstrate knowledge of the basic and clinical science of surgery in sufficient breadth and depth to ensure that he/she passes the American Board of Surgery Qualifying Examination in General Surgery following completion of residency. This shall be measured through consistent achievement of a score equal to or higher than the fiftieth percentile in the annual American Board of Surgery In-Training Examination in General Surgery; and through consistent achievement of a score above average in the written quarterly In-Training Examination, the monthly mock oral examinations for PGY IV and V and in the monthly departmental evaluation of fund of knowledge by supervising faculty in the six competency areas.

Psychomotor

The resident shall demonstrate experience and skill in technical aspects of surgical treatment in sufficient breadth and depth to assure mastery of fundamental and complex operations in each of the primary components of general surgery, supplemented as appropriate by operative experience in the secondary components of general surgery. This shall be measured through satisfactory performance of fifty percent of the minimum operative experience targets recommended by the Residency Review Committee in General Surgery of the Accreditation Council for Graduate Medical Education in each of the primary components of general surgery, supplemented as appropriate by operative experience in the secondary components of general surgery is achieved by the end of the PGY-4 year. One hundred percent of these targets must be met at the end of the PGY-5 year.

Analytical

The resident shall demonstrate the ability to collect and analyze scientific and clinical data, and to reach logical conclusions and propose rational courses of action based upon data collection and analysis, commensurate with the level of professional development as a general surgeon. This shall be measured through consistent achievement of an average or better score on the monthly departmental evaluation of surgical judgment by supervising faculty.

Affective
The resident shall demonstrate attitude and behavior appropriate for a compassionate and caring physician commensurate with the level of professional development as a general surgeon. This shall be measured through consistent achievement of an average or better score on the monthly departmental evaluation of professional demeanor by supervising faculty.

The Residency Advisory Committee is made up of the Director of Surgery, Program Director, the Associate Program Director, Associate Directors, Section Chiefs, the Director of Surgery at Woodhull Hospital, the Chief Residents and selected attendings. The Advisory Committee meets periodically to review the program's goals and objectives

The Advisory Committee also reviews the monthly evaluations of the residents and meets with the residents individually twice a year to both discuss their evaluations and to hear what each resident perceives as being the strengths and weaknesses of the program.

The residents shall rotate through General Surgery from PGY I to PGY 5 with increasing responsibility for at least 60 months. 54 months will be spent to cover clinical assignments in Surgery of which 42 months will be in the essential content areas of surgery.

PGY 1 residents shall rotate and be introduced to the primary components as well as secondary components of surgery, including Neurosurgery, Urology, Plastic Surgery and Orthopedics.

PGY 2 residents shall rotate to continue covering all the primary components of surgery with emphasis on Critical Care and the secondary components, including Pediatric surgery, Burns and Endoscopy.

PGY 3 residents continue with the primary components with increasing responsibility and with special attention to Surgical Oncology and in the secondary components with special attention to transplant and endoscopy.

PGY 4 and 5 residents focus principally on the primary components of surgery with increasing responsibility and diversity. Additionally, they oversee the junior residents’ activities in the primary as well as the secondary components.

The residents’ professionalism, interpersonal relationship and communication skills, patient care, etc. shall not be assessed only by the attendings but also by their peers and other staff members (e.g. physician assistants, nurses) they work with during the rotation.